Is obesity paradox valid for critically-ill COVID-19 patients with respiratory failure?

• Published in: Turkish Thoracic Journal Vol. 23; no. 4; pp. 268 - 276
• Main Authors: Sezer, Havva, Canbaz, Hande Bulut, Yurdakul, Fatma, Ozserezli, Bogac, Yazici, Dilek
• Format: Journal Article
• Language: English
• Published: AVES 01-07-2022; Turkish Thoracic Society
• Subjects: Acute respiratory distress syndrome; Causes of; Complications and side effects; Critically ill; Obesity; Original; Patient outcomes; Prognosis; Turkey
• ISSN: 1302-7808; 2148-7197; 2149-2530
• DOI: 10.5152/TurkThoracJ.2022.21139

OBJECTIVE: We aimed to analyze the association between body mass index and mortality in patients with coronavirus disease 2019 induced acute respiratory distress syndrome. MATERIAL AND METHODS: In this retrospective cohort study, we analyzed 108 consecutive patients admitted in the intensive care unit for coronavirus disease 2019-induced lung disease in a single center between March 2020 and February 2021. Coronavirus disease 2019 infection was confirmed by real-time reverse transcription-polymerase chain reaction assay of nasal swabs or lower respiratory tract samples. Acute respiratory distress syndrome was defined using Berlin criteria. Acute respiratory distress syndrome severity was assessed with partial pressure of arterial oxygen/fraction of inspired oxygen ratio. We categorized patients according to the body mass index as underweight, <18.5 kg/[m.sup.2]; normal weight, from 18.5 kg/[m.sup.2] to <25 kg/[m.sup.2]; overweight, from 25 kg/[m.sup.2] to <30 kg/[m.sup.2]; obese, [greater than or equal to] 30 kg/[m.sup.2]. Clinical characteristics and mortality were compared among groups. Demographic and clinical data were collected from electronic medical records of the hospital system. RESULTS: The mean age was 67.3 [+ or -] 13.3 years. Study participants were predominantly males (66.7%). The mean BMI was 28.2 [+ or -] 5.6 kg/[m.sup.2]. There were 2 patients (2%), 28 (26%), 42 (39%), and 36 patients (33%) in the underweight, normal-weight, overweight, and obese groups, respectively. The hospital mortality was 40.7%. There was no association between body mass index and mortality (P = .09). In multivariate analysis, mortality was associated with the presence of cancer [odds ratio = 7.338 (1.636-32.914), P =.009], and time between diagnosis and intubation [odds ratio = 1.318 (1.150-1.509), P [less than or equal to] .001]. CONCLUSION: Neither acute respiratory distress syndrome severity nor mortality was higher in patients with higher body mass index compared to the ones with normal body mass index. KEYWORDS: Body mass index, acute respiratory distress syndrome, COVID-19, obesity paradox, mortality Received: May 24, 2021 Accepted: March 1, 2022 Available Online: April 22, 2022